“There is no health without oral health, and no personalized prevention without Guided Biofilm Therapy!”
The participants of the hands-on course with dr Gerhard in Dubai, UAE during the 37th Int’l Dental ConfEx CAD/CAM Digital & Oral Facial Aesthetics, hosted at the esteemed Madinat Jumeirah Arena & Conference Centre in Dubai, UAE. (Image: EMS)
Can you start by telling us a bit about yourself and your professional journey in dentistry?
I would like to talk about the start of my journey in medicine as a male nurse with experience gathered in maxillofacial surgery departments, intensive care units, and severe burns units. Very early, I learned to handle patient safety and team safety, avoiding cross-contamination and thus making it possible for optimal healing conditions. I studied dentistry at Würzburg University, Germany, and received my degree in 1985. I settled down in Cagliari, Sardinia, Italy, as a private practitioner with a focus on oral surgery and periodontology. As an assistant professor at Università degli Studi di Cagliari, Italy, I taught clinical periodontology, implant surgery, and periodontal surgery, and as an associate professor, oral surgery and implant surgery at Universitatae de Medicină și Farmacie “Grigore T. Popa Iași, Romania.
My interest was always driven by the idea of combining the best technology with minimally invasive protocols when possible, and showing maximum respect for the biology of tissues to achieve the best healing outcomes. Besides the importance of operative procedures, we have always put an emphasis on guiding our patients towards health maintenance by coaching them individually. I engaged in organized dentistry as the President of the AIO Italian Dental Association, as the President of the European Regional Organization of the FDI World Dental Federation, as a Councilor, a Speaker of the General Assembly of FDI, and later as the President of FDI, and as the President of the Academy of Dentistry International, a humanitarian organization promoting education and global oral health. It was, and it still is, not uncommon to see me involved in health-political venues, health advocacy, and sharing my knowledge in scientific programs at dental events on a global scale.
What is the Guided Biofilm Therapy (GBT) protocol, and why is it significant in modern dentistry?
The Guided Biofilm Therapy protocol is a modified oral prophylaxis protocol. It differs from the traditional prophylaxis approach in the following steps:
Disclosing guides towards a precise removal of biofilm, which allows for an easier detection of calculus. It is a tool for both the dentist and the patient, because it’s a minimally invasive protocol.
In addition, Airflow Max, a soluble particle-loaded spray, assures non-invasive biofilm and calculus removal from teeth and a gentle debridement of root surfaces. Furthermore, Perioflow allows minimally invasive biofilm removal from 4 to 9 mm periodontal pockets with a 14 μm soluble erythritol-loaded spray, while better preserving cementum and root dentin.
Piezon PS slim ultrasonic instrument allows for painless calculus removal in deep periodontal pockets, and the Piezon PI Max, as slim as a periodontal probe and made of carbon-reinforced polyether ether ketone (PEEK), makes biofilm and calculus removal up to 3 mm around implants and restorations a respectful procedure for oral tissues.
Finally, the final check is an opportunity to chemically fortify teeth with topical fluoride, detect tooth decay early, and practice a rehearsal with the patient.
The GBT protocol involves a modular, systematic, and risk-adapted clinical protocol for primary, secondary, and tertiary prevention, becoming an evolution of Axelsson’s and Lindhe’s prevention concept, based on their studies in the seventies and eighties, with indications for periodontal and peri-implant disease prevention and care.
However, GBT is so much more than the mere process linked to biofilm and calculus removal, and it is, definitely, not a substitute for protocols with curettes and sonic or ultrasonic devices. I personally see it as a way to optimize oral health maintenance by guiding the patient to adopt behavior changes towards an overall health concept, of which oral health is an intrinsic part. There is no health without oral health, and there is no biofilm therapy that considers the avoidance of biofilm as Guided Biofilm Therapy does. This needs an individual, personalized approach, leading to the prevention of tooth decay and periodontal disease, guaranteeing predictable treatment results, and enabling the patient to actively participate—in short: the 4 Ps of the concept of modern medicine. Patient compliance increases with growing health and oral health literacy. When adequate hydration and reduced liberal sugar intake are combined with a reduction of the inflammatory gradient of cells, it is understood that this benefits healing processes and facilitates the maintenance of a healthy mouth and a healthy body.
How does GBT benefit orthodontic treatments, and why is it considered a game changer?
Orthodontic treatments obstruct patients’ homecare and often require the assistance of a professional to keep the risk of the onset of dental caries, periodontal, and peri-implant mucositis low. The minimally invasive GBT procedure guarantees higher efficiency in cleaning the orthodontic device, penetrating each and every microspace, and is more time- and, thus, cost-effective. Patients appreciate these aspects and show better compliance during treatments in the dental practice and higher performance in their oral care at home. New orthodontic treatment options with aligners involve attachments. These attachments are subject to stain and food retention. There is actually no better alternative to brushes and cleaning pastes than GBT. The Airflow procedure easily removes stains and other food microparticles while leaving the shape and, therefore, the function of the composite attachments intact and functional. This also results in shorter and uneventful treatment time at a higher comfort level. The game has changed from an orthodontic treatment associated with higher caries and gingivitis risk years ago to a more relaxed win-win concept for patients and their orthodontists today.
In implant maintenance, how does GBT improve care, and what is the role of the implant scaling instrument, PI Max?
The PI Max – in full, Piezon Implant Max – is not a scaling but an oscillating instrument, generating precise, linear vibrations without any lateral deflection. It is a specific instrument for implant materials, which need special maintenance with instruments made of a material that will neither change the macro- and micro-morphology nor contaminate the implant surfaces with substances that could increase the risk of peri-implant mucositis and peri-implantitis. The efficiency of implant curettes is questionable. Other sonic or ultrasonic instruments made of PEEK are quite large in size and could more easily jeopardize peri-implant tissue integrity. The new PI Max instrument is made of PEEK reinforced with 30% carbon, and it is half or even less than the size of the PEEK instruments on the market, just like a PEEK probe. This guarantees better accessibility up to 3 mm of peri-implant pocket depth, and the tissue-friendly Piezon technology keeps the risk of soft tissue damage low.
What differentiates the Plus powder used in GBT, and why is it considered safe for patients?
The EMS Plus powder is a 14 μm soluble erythritol powder. Erythritol is a polyol, a sugar substitute also used in foods. As it is chemically stable, non-hygroscopic, pleasant-tasting, minimally abrasive on root surfaces, and highly efficient, it has become the all-around powder for GBT, indicated in more than 95% of clinical cases. Due to these characteristics, it has become the patients’ and dentists’ favorite for plaque and calculus removal and control, as previously mentioned. The difference between this powder and others is the very small size and the high number of particles, which, together with the patented “laminar flow technique,” makes its use comfortable, efficient, and safe for the patient. If erythritol is accidentally inhaled into the lungs, being soluble, it is absorbed without any consequence for the organism. EMS has developed a specific suction instrument – Flow Control – which makes an already safe procedure even safer and more comfortable for the patient.
Could you share some highlights from the hands-on course you conducted during the CAD/CAM Digital & Oral Facial Aesthetics 37th Int’l Dental Conference and the feedback you received from participants?
It has been a pleasure to work with the participants, and a lecture very early transformed into an engaging, interactive session, allowing for a vivid and hands-on course. The practical hints given were greatly appreciated, especially the sound feedback during suction, indicating that the procedure is effective. Participants valued the practical part, as they could experience firsthand the benefits of the laminar flow technique, which allows for more precision during biofilm and calculus removal and less dispersion of the particle-loaded spray in the Airflow procedure.
Thank you.
